Screening for Tuberculosis Infection. Harlingen, TX. Linda Dooley, MD has the following disclosures to make:

Size: px
Start display at page:

Download "Screening for Tuberculosis Infection. Harlingen, TX. Linda Dooley, MD has the following disclosures to make:"

Transcription

1 TB Infection Diagnosis Recommendations Talk Developed by Lisa Y. Armitige, MD, PhD Medical Consultant, Heartland National TB Center Associate Professor Internal Medicine/Pediatrics/Infectious Disease UT Health Northeast, Tyler, Texas Presented by Linda Dooley, MD TB Physician Austin Public Health September 20, 2017 Screening for Tuberculosis Infection September 20, 2017 Harlingen, TX EXCELLENCE EXPERTISE INNOVATION Linda Dooley, MD has the following disclosures to make: No conflict of interests No relevant financial relationships with any commercial companies pertaining to this educational activity 1

2 TB Infection Diagnosis Recommendations September 20, 2017 Harlingen,Texas Talk Developed by Lisa Y. Armitige, MD, PhD Medical Consultant, Heartland National TB Center Associate Professor Internal Medicine/Pediatrics/Infectious Disease UT Health Northeast, Tyler, Texas Presented by Linda Dooley, MD TB Physician Austin Public Health Screening for Tuberculosis Along the US/Mexico Border San Antonio, Texas June 10, 2016 EXCELLENCE EXPERTISE INNOVATION TB INFECTION 2

3 TB EXPOSURE Your patient and someone who has active pulmonary TB have been sharing airspace CHARACTERIZING THE EXPOSURE Frequency and duration of exposure Dilution effect (volume of air) Ventilation Exposure to ultraviolet light AJCCRM. 2005: 170;

4 RISK OF TB TRANSMISSION AJCCRM. 2005: 170; TB INFECTION The TB organism has breached the barriers set up by the immune system and has caused infection Outcome of TB Infection Latent TB Infection (LTBI) (90%) No Active TB Disease Active TB Disease (10%) 50% Primary Progression in first 2 years 50% Reactivation later in life 4

5 Clinical Presentation of LTBI No symptoms or signs of infection Positive tuberculin skin test or IGRA Chest x ray may be normal, or show granulomata, pleural or parenchymal scarring NOT infectious LTBI ACTIVE TB DISEASE Recent infection HIV infection Chest x ray abnormality Underweight by >10% Intravenous drug use Immunosuppression ATS CDC. Am J Respir Crit Care Med 2000;161:S221 5

6 LTBI ACTIVE TB DISEASE Immunosuppression HIV Hematologic cancers Medical Co morbidities Medications TNF α inhibitors Prednisone >15 mg, > 4 weeks Chemotherapy Other immunosuppressive drugs (e.g. other biologics, anti rejection medications) Percent Risk of Disease by Age Age at Infection Risk of Active TB Birth 1 year* 43% 1 5 years* 24% 6 10 years* 2% years* 16% Healthy Adults 5 10% lifetime risk HIV Infected Adults % lifetime *Miller, Tuberculosis in Children Little Brown, Boston, WHO,

7 LATENT TB INFECTION What s really happening? The bacteria that cause disease are dormant (metabolically inactive). For reasons that are not clear, they wake up and start to divide. OR Bacteria are metabolically active and dividing, but the infection is somehow controlled by the immune system. i.e. disease develops when immunity is somehow compromised TB Infection Diagnosis 7

8 Who Should be Tested for TB Infection? Targeted Testing for TB Infection The simplified version: Persons who are at increased risk for M. tuberculosis infection Persons at increased risk for progression to active disease if infected with M. tuberculosis (even if not at increased exposure risk) And those who tend to be tested in addition: Persons tested for administrative reasons (e.g., mandatory employment testing) Persons with symptoms of active TB disease (fever, night sweats, cough, and weight loss) Who Should be Tested for TB Infection? Targeted Testing for TB Infection Contacts of persons with active TB HIV positive individuals Recent immigrants (<5 yrs) from high prevalence countries Injection Drug Users Residents and Employees of high risk congregate settings: Correctional facilities and Homeless Shelters Hospitals, Clinics, Nursing Homes, Substance Abuse Facilities Newest Category: Patients considering treatment with TNF α Antagonists Children exposed to high risk adults or environments 8

9 Contacts of Active TB Case Among close contacts to a TB Case: 30% have TB Infection 1 3% have active TB disease Without TB Infection treatment: 10% with TB Infection with develop Active TB Approximately 5% of contacts with newly acquired TB Infection progress to TB disease within 2 years The other 5% activate > 2 years after acquisition Examination of contacts is one of the most effective strategies for TB Infection diagnosis and TB control! MMWR December 16, 2005 / Vol. 54 / No. RR 15 30,000 Reported TB Cases United States, * 25,000 No. of Cases 20,000 15,000 10,000 5,000 0 *Updated as of June 5, Year 9

10 20,000 Number of TB Cases in U.S.-born vs. Foreign-born Persons, United States, * 15,000 No. of Cases 10,000 5,000 0 U.S. born Foreign born *Updated as of June 5, No. of Cases Trends in TB Cases in Foreign born Persons, United States, * Percentage % % % % % % % 0 0% Number of Cases Percent of Total Cases *Updated as of June 5,

11 Who Should be Tested for TB Infection? Targeted Testing for TB Infection Contacts of persons with active TB HIV positive individuals Recent immigrants (<5 yrs) from high prevalence countries Injection Drug Users Residents and Employees of high risk congregate settings: Correctional facilities and Homeless Shelters Hospitals, Clinics, Nursing Homes, Substance Abuse Facilities Newest Category: Patients considering treatment with TNF α Antagonists Children exposed to high risk adults or environments Percent of Foreign born with TB by Time of Residence in U.S. Prior to Diagnosis, % 80% 60% 40% 20% 0% Mexico Philippines Vietnam All Other Foreignborn Unknown* <1 year 1 4 years 5 years *Foreign born TB patients for whom information on length of residence in the U.S. prior to diagnosis is unknown or missing. 11

12 Tests for Diagnosis of TB Infection TB Infection Diagnostics TB Skin Test (TST) Interferon Gamma Release Assays (IGRA) 12

13 TB Skin Test (TST) Uses Purified Protein Derivative (PPD) PPD is given via intradermal injection Read induration, not erythema, at hrs TB Skin Test (TST) Pros: Inexpensive Simple to perform (if you know what you are doing) Cons: Must return in hrs Interpretation is somewhat subjective False Negatives: Elderly Immunosuppressed False Positives: Low risk populations Non tuberculous mycobacteria BCG vaccination 13

14 Reading the TB Skin Test Measure induration, not erythema!!! 14

15 Induration of 5mm Considered a Positive TST HIV positive persons Recent contacts of TB cases Fibrotic Changes on CXR c/w prior TB Patients with organ transplants or other immunosuppression Prednisone therapy 15 mg/day > 1 month CDC. June 2000 Induration of 10mm Considered a Positive TST Recent arrivals (<5 yrs?) high prevalence countries IVDU Residents/employees high risk congregate facilities (health care, prisons, shelters, etc.) TB lab personnel Children < 4 years old or exposed to adults at risk Persons with high risk medical conditions CDC. June

16 Induration of 10mm Considered a Positive TST Persons with high risk medical conditions Silicosis Diabetes Chronic renal failure Hematologic disorders/leukemia/lymphoma Cancers, particularly head/neck and lung Low body weight less than 10% below ideal body weight Gastrectomy Jejunal bypass CDC. June 2000 Induration of 15mm Considered a Positive TST Persons with no risk factors (Why was a TST placed?) CDC. June

17 Interferon Gamma Release Assays (IGRAs) TST vs In vitro Assays Andersen et al. Lancet 2000;356:

18 Antigens Specific to M. tuberculosis Cole et al, Nature 1998 Ganguly et al, Tuberculosis (2008):88, Genetic Region of Difference 1 (RD 1) Not found in BCG or most NTM NTM exceptions: M. kansasii, M. szulgai, M. marinum Codes for 9 proteins Two proteins were found to produce strong immunologic responses in persons infected with M. tuberculosis 10 kda culture filtrate protein (CFP 10) 6 kda early secreted target antigen (ESAT 6) 18

19 Antigens for Newer Generation IGRAs Negative control or nil (e.g., saline, heparin) Positive control or mitogen: non specific immune response stimulator (e.g., phytohemagglutinin) M. tuberculosis specific antigens Unlike PPD used in TST, do not cross react with BCG or NTM (some exceptions) ESAT 6, CFP 10, TB 7.7 (actually simulated using overlapping peptides) Antigens for Gamma Release Assays 19

20 FDA Approved IGRAs QuantiFERON TB Gold In Tube (QFT GIT) Stage 1: Whole Blood Culture in special blood collection tubes Mtb* Nil PHA Collect 1mL of blood in 3 tubes Incubate at 37ºC for hours Centrifuge 5 minutes to separate plasma above gel Stage 2: Measure [IFN ] & Interpret Mtb COLOR Nil PHA TMB Collect 50 µl of plasma for ELISA Measure [ IFN ] in Sandwich ELISA Software calculates results and prints report *Mtb = ESAT 6 + CFP 10 + TB

21 T Spot.TB (T Spot) Collect blood in CPT tube Recover, wash, & count PBMCs Aliquot 250,000 PBMCs to 4 wells with anti IFN Add saline, PHA, ESAT 6 or CFP 10 & incubate Wash away cells Develop & count spots where cells produced IFN IFN Antibody Sensitized T cell IFN Captured Detection Antibody Chromogen Spot Saline ESAT 6 CFP 10 PHA What Result is Considered Positive? Depends on the test Based on calculation of IFN response to TB antigens relative to IFN response to nil Unlike TST, not risk stratified (i.e., there are not multiple cutoffs for different risk groups) Still somewhat complicated Software performs calculations 21

22 Nil (IU/mL) Interpretation Criteria for the QFT GIT Test TB Antigen minus Nil (IU/mL) QFT-GIT (IU/mL) Mitogen Interpretation or < 25% of Nil value Negative 5.0 M. tuberculosis infection unlikely and 25% of Nil value Positive ANY M. tuberculosis infection likely 8.0 ANY Indeterminate ANY Indeterminate and or < 25% of Nil value Indeterminate < 5.0 Indeterminate QuantiFERON TB Gold Mori et al 2004 Am J Respir Crit Care Med,170:

23 Interpretation Criteria for the T Spot.TB Result Nil* TB Response# # Mitogen++ Interpretation+ Positive 10 spots 8 spots Any M.tuberculosis infection likely Borderline 10 spots 5, 6, or 7 spots Any Uncertain likelihood of M. tuberculosis infection Negative 10spots 4 spots M Tb infection unlikely Indeterminate > Any < 5 spots Any < 20 spots Uncertain likelihood of M. tuberculosis infection T Spot.TB 23

24 Indeterminate and Borderline Results Indeterminate Negative control result is too high High background production of IFN Positive control result is too low Immunocompromised patients may not respond to mitogen Borderline (T Spot only) Falls within borderline zone close to negative/positive cut point CDC Guidelines 24

25 Recommendations 25

26 CDC Recommendations TST or IGRAs should be used as aids in diagnosing infection with M. tuberculosis Both the standard qualitative test interpretation and the quantitative assay measurements should be reported As with the TST, IGRAs generally should not be used for testing persons who have a low risk of infection and a low risk of disease due to M. tuberculosis CDC Recommendations Populations/situations in which IGRAs are preferred testing persons from groups that historically have poor rates of return for TST reading testing persons who have received BCG (as a vaccine or for cancer therapy) 26

27 CDC Recommendations Populations/situations in which TST is preferred testing children younger than 5 years old IGRAs and the 2015 AAP RED BOOK Can use IGRAs in immunocompetent children > 4 years of age in all situations when a TST would be used Preferred test for children 5 years and older who have received a BCG vaccination Data shows IGRAs perform consistent well in children 5 years and older, some experts use down to 3 y/o Neither IGRAs nor the TST are perfect; always need clinical judgment! 27

28 AAP RedBook 2015 CDC Recommendations Populations/situations in which there is no preference between IGRAs and TST testing recent contacts of persons with infectious tuberculosis periodic screening that addresses occupational exposure to TB (e.g., surveillance programs for healthcare workers) 28

29 CDC Recommendations Routine testing with both TST and an IGRA is not recommended Results from both tests may be useful when the initial test is negative if increased sensitivity is desired (considered infected if either test is positive) risk of infection, the risk of progression, and the risk of a poor outcome are increased clinical suspicion of active tuberculosis and confirmation of M. tuberculosis infection is desired Results from both tests may be useful when the initial test is positive if increased specificity is desired (considered infected only if both tests are positive) additional evidence of infection is required to encourage compliance (such as in foreignborn healthcare workers who believe their positive TST is due to BCG) in healthy persons who have a low risk of both infection and progression CDC Recommendations Repeating an IGRA or performing a TST may be useful when the initial IGRA result is indeterminate, borderline, or invalid, and a reason for testing persists 29

30 CDC Recommendations A diagnosis of M. tuberculosis infection, and the decisions about medical or public health management should include epidemiological, historical, and other clinical information when using IGRA or TST results Decisions should not be based on IGRA or TST results alone Particularly relevant for managing discordant test results (e.g., TST+/QFT ) Sources of variability for QFT GIT Clin. Microbiol. Rev. 2014, 27(1):

31 Pearls for TST vs. IGRAs Discordance between the TST and IGRAs has been measured up to 20% in patients known to be infected with Mtb. Don t order both tests, pick the right test to start with! Who are you testing? IGRAs shine when used in BCG vaccinated populations (increased specificity) NO study has shown the IGRA to be better in US born (or non BCGvaccinated) individuals. The TST can be used AND trusted in this population No test (TST or IGRA) overrides clinical, epidemiologic or historical data Testing is good and necessary! But is it funded..? 31

32 USPSTF recommendations for LTBI Examples of USPSTF A and B ratings Topic Grade Release Date Bacteriuria screening: pregnant women A July 2008 Blood pressure screening in adults A October 2015 Cervical cancer screening A March 2012 Cholesterol abnormalities screening: men 35 and older A June 2008 Cholesterol abnormalities screening: women younger than 45 A June 2008 Abdominal aortic aneurysm screening: men B June 2014 Alcohol misuse: screening and counseling B May 2013 Aspirin preventive medication: Adults aged 50 to 59 years with a 10% 10 year cardiovascular risk B April 2016 BRCA risk assessment and genetic counseling/testing B December a and b recommendations/ 32

33 USPSTF and the Affordable Care Act (Coverage of Preventive Services) Public Health Service (PHS) Act section 2713 and the interim final regulations relating to coverage of preventive services require non grandfathered group health plans and health insurance coverage offered in the individual or group market to provide benefits for, and prohibit the imposition of cost sharing requirements with respect to, the following: Evidenced based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force (USPSTF) with respect to the individual involved, except for the recommendations of the USPSTF regarding breast cancer screening, mammography, and prevention issued on or around November 2009, which are not considered current CMS.gov: Sheets and FAQs/aca_implementation_faqs18.html Questions? Easy Questions: Linda.Dooley@austintexas.gov All Other Questions: Lisa.Armitige@dshs.state.tx.us Or Heartland Consultants TEX LUNG 33

TB Nurse Case Management San Antonio, Texas July 18 20, 2012

TB Nurse Case Management San Antonio, Texas July 18 20, 2012 TB Nurse Case Management San Antonio, Texas July 18 20, 2012 IGRA s and Their Use in TB Nurse NCM Lisa Armitige, MD, PhD July 18, 2012 Lisa Armitige, MD, PhD has the following disclosures to make: No conflict

More information

Barbara J Seaworth MD Medical Director, Heartland National TB Center Professor, Internal Medicine and Infectious Disease UT Health Northeast

Barbara J Seaworth MD Medical Director, Heartland National TB Center Professor, Internal Medicine and Infectious Disease UT Health Northeast Practical Aspects for Using the Interferon Gamma Release Assay (IGRA) Test Live Webinar July 14, 2017 Barbara J Seaworth MD Medical Director, Heartland National TB Center Professor, Internal Medicine and

More information

TB Intensive San Antonio, Texas November 11 14, 2014

TB Intensive San Antonio, Texas November 11 14, 2014 TB Intensive San Antonio, Texas November 11 14, 2014 Interferon Gamma Release Assays Lisa Armitige, MD, PhD November 12, 2014 Lisa Armitige, MD, PhD has the following disclosures to make: No conflict of

More information

TB Intensive Houston, Texas October 15-17, 2013

TB Intensive Houston, Texas October 15-17, 2013 TB Intensive Houston, Texas October 15-17, 2013 Interferon Gamma Release Assays (IGRA s) Lisa Armitige, MD, PhD October 16, 2013 Lisa Armitige, MD, PhD has the following disclosures to make: No conflict

More information

Evaluation and Treatment of TB Contacts Tyler, Texas April 11, 2014

Evaluation and Treatment of TB Contacts Tyler, Texas April 11, 2014 Evaluation and Treatment of TB Contacts Tyler, Texas April 11, 2014 Interferon Gamma Release Assays: Understanding the Test David Griffith, BA, MD April 11, 2014 David Griffith, BA, MD has the following

More information

Diagnosis and Medical Management of TB Infection Lisa Y. Armitige, MD, PhD September 12, TB Nurse Case Management September 12 14, 2017

Diagnosis and Medical Management of TB Infection Lisa Y. Armitige, MD, PhD September 12, TB Nurse Case Management September 12 14, 2017 Diagnosis and Medical Management of TB Infection Lisa Y. Armitige, MD, PhD September 12, 2017 TB Nurse Case Management September 12 14, 2017 EXCELLENCE EXPERTISE INNOVATION Lisa Y. Armitige, MD, PhD has

More information

TB Intensive Tyler, Texas December 2-4, 2008

TB Intensive Tyler, Texas December 2-4, 2008 TB Intensive Tyler, Texas December 2-4, 2008 Interferon Gamma Releasing Assays: Diagnosing TB in the 21 st Century Peter Barnes, MD December 2, 2008 TOPICS Use of interferon-gamma release assays (IGRAs)

More information

Advanced Management of Patients with Tuberculosis Little Rock, Arkansas August 13 14, 2014

Advanced Management of Patients with Tuberculosis Little Rock, Arkansas August 13 14, 2014 Advanced Management of Patients with Tuberculosis Little Rock, Arkansas August 13 14, 2014 Tuberculosis Pathogenesis and Treatment of Latent TB Infection Lisa Armitige, MD, PhD August 13, 2014 Lisa Armitige,

More information

Contracts Carla Chee, MHS May 8, 2012

Contracts Carla Chee, MHS May 8, 2012 Moving Past the Basics of Tuberculosis Phoenix, Arizona May 8-10, 2012 Contracts Carla Chee, MHS May 8, 2012 Carla Chee, MHS has the following disclosures to make: No conflict of interests No relevant

More information

Making the Diagnosis of Tuberculosis

Making the Diagnosis of Tuberculosis Making the Diagnosis of Tuberculosis Alfred Lardizabal, MD NJMS Global Tuberculosis Institute Testing for TB Infection Targeted Testing: Key Points Test only if plan for ensuring treatment De-emphasizes

More information

Diagnosis Latent Tuberculosis. Disclosures. Case

Diagnosis Latent Tuberculosis. Disclosures. Case Diagnosis Latent Tuberculosis Neha Shah MD MPH Field Medical Officer Tuberculosis Control Branch California Department of Public Health Centers for Disease Control and Prevention September 2016 1 Disclosures

More information

Approaches to LTBI Diagnosis

Approaches to LTBI Diagnosis Approaches to LTBI Diagnosis Focus on LTBI October 8 th, 2018 Michelle Haas, M.D. Associate Director Denver Metro Tuberculosis Program Denver Public Health DISCLOSURES I have no disclosures or conflicts

More information

Peggy Leslie-Smith, RN

Peggy Leslie-Smith, RN Peggy Leslie-Smith, RN EMPLOYEE HEALTH DIRECTOR - AVERA TRAINING CONTENT 1. South Dakota Regulations 2. Iowa Regulations 3. Minnesota Regulations 4. Interferon Gamma Release Assay (IGRA)Testing 1 SOUTH

More information

Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection (LTBI) Lloyd Friedman, M.D. Milford Hospital Yale University

Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection (LTBI) Lloyd Friedman, M.D. Milford Hospital Yale University Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection (LTBI) Lloyd Friedman, M.D. Milford Hospital Yale University Tuberculosis Estimates USA World Infection 15,000,000 2,000,000,000

More information

Using Interferon Gamma Release Assays for Diagnosis of TB Infection

Using Interferon Gamma Release Assays for Diagnosis of TB Infection Learning Objectives Using Interferon Gamma Release Assays for Diagnosis of TB Infection 1. Describe available Interferon Gamma Release Assay tests for TB infection and how they work. 2. Understand interpretation

More information

TB Skin Test Practicum Houston, Texas Region 6/5 South September 23, 2014

TB Skin Test Practicum Houston, Texas Region 6/5 South September 23, 2014 TB Skin Test Practicum Houston, Texas Region 6/5 South September 23, 2014 Catalina Navarro, BSN, RN has the following disclosures to make: No conflict of interests No relevant financial relationships with

More information

Mycobacterial Infections: What the Primary Provider Should Know about Tuberculosis

Mycobacterial Infections: What the Primary Provider Should Know about Tuberculosis Mycobacterial Infections: What the Primary Provider Should Know about Tuberculosis Henry F. Chambers, M.D Professor of Medicine, UCSF Topics for Discussion Epidemiology Diagnosis of active TB Screening

More information

Tuberculosis Intensive

Tuberculosis Intensive Tuberculosis Intensive San Antonio, Texas April 3 6, 2012 Tuberculosis Pathogenesis Lynn Horvath, MD April 3, 2012 Lynn Horvath, MD has the following disclosures to make: No conflict of interests No relevant

More information

Tuberculosis Pathogenesis

Tuberculosis Pathogenesis Tuberculosis Pathogenesis Renuka Khurana, MD, MPH May 12, 2015 TB for Community Providers May 12, 2015 Phoenix, Arizona EXCELLENCE EXPERTISE INNOVATION Renuka Khurana, MD, MPH has the following disclosures

More information

TB in Corrections Phoenix, Arizona

TB in Corrections Phoenix, Arizona TB in Corrections Phoenix, Arizona March 24, 2011 Treatment of Latent TB Infection Renuka Khurana MD, MPH March 24, 2011 Renuka Khurana, MD, MPH has the following disclosures to make: No conflict of interests

More information

TB Prevention Who and How to Screen

TB Prevention Who and How to Screen TB Prevention Who and How to Screen 4.8.07. IUATLD 1st Asia Pacific Region Conference 2007 Dr Cynthia Chee Dept of Respiratory Medicine / TB Control Unit Tan Tock Seng Hospital, Singapore Cycle of Infection

More information

Conflict of Interest Disclosures:

Conflict of Interest Disclosures: Mady Slater, M.D. Stanford University Medical Center Division of Infectious Diseases 04/23/14 WOEMA webinar Conflict of Interest Disclosures: I have no financial relationships with commercial entities

More information

Technical Bulletin No. 172

Technical Bulletin No. 172 CPAL Central Pennsylvania Alliance Laboratory QuantiFERON -TB Gold Plus Assay Contact: J Matthew Groeller, MPA(HCM), MT(ASCP), 717-851-4516 Operations Manager, Clinical Pathology, CPAL Jennifer Thebo,

More information

Diagnosis and Medical Management of Latent TB Infection

Diagnosis and Medical Management of Latent TB Infection Diagnosis and Medical Management of Latent TB Infection Marsha Majors, RN September 7, 2017 TB Contact Investigation 101 September 6 7, 2017 Little Rock, AR EXCELLENCE EXPERTISE INNOVATION Marsha Majors,

More information

LATENT TUBERCULOSIS. Robert F. Tyree, MD

LATENT TUBERCULOSIS. Robert F. Tyree, MD LATENT TUBERCULOSIS Robert F. Tyree, MD 1 YK TB OFFICERS Ron Bowerman Elizabeth Roll Mien Chyi (Pediatrics) Cindi Mondesir (Pediatrics) The new guys: Philip Johnson Robert Tyree 2009 CDC TB CASE DEFINITION

More information

Diagnosis and Medical Case Management of Latent TB. Bryan Rock, MD April 27, 2010

Diagnosis and Medical Case Management of Latent TB. Bryan Rock, MD April 27, 2010 TB Nurse Case Management Lisle, Illinois April 27-28, 28 2010 Diagnosis and Medical Case Management of Latent TB Infection Bryan Rock, MD April 27, 2010 DIAGNOSIS AND MANAGEMENT OF LATENT TUBERCULOSIS

More information

Why need to havetb Clearance. To Control and Prevent Tuberculosis

Why need to havetb Clearance. To Control and Prevent Tuberculosis Why need to havetb Clearance To Control and Prevent Tuberculosis How to ID Tuberculosis There are two kinds of tests that are used to determine if a person has been infected with TB bacteria: the tuberculin

More information

CHILDHOOD TUBERCULOSIS: NEW WRINKLES IN AN OLD DISEASE [FOR THE NON-TB EXPERT]

CHILDHOOD TUBERCULOSIS: NEW WRINKLES IN AN OLD DISEASE [FOR THE NON-TB EXPERT] CHILDHOOD TUBERCULOSIS: NEW WRINKLES IN AN OLD DISEASE [FOR THE NON-TB EXPERT] QUESTION: : Which children in the United States should get a tuberculin skin test? Do questionnaires really work? Jeffrey

More information

TB Intensive San Antonio, Texas December 1-3, 2010

TB Intensive San Antonio, Texas December 1-3, 2010 TB Intensive San Antonio, Texas December 1-3, 2010 TB Pathogenesis and Transmission Lynn Horvath, MD; TCID December 1, 2010 Tuberculosis Pathogenesis Lynn L. Horvath, MD, FACP, FIDSA Associate Professor

More information

Latent TB Infection (LTBI)

Latent TB Infection (LTBI) Latent TB Infection (LTBI) Diagnosis & Treatment of Latent TB Infection (LTBI) Amee Patrawalla MD MPH Assistant Professor UMDNJ-New Jersey Medical School Infection with Mycobacterium tuberculosis without

More information

What the Primary Physician Should Know about Tuberculosis. Topics for Discussion. Life Cycle of M. tuberculosis

What the Primary Physician Should Know about Tuberculosis. Topics for Discussion. Life Cycle of M. tuberculosis What the Primary Physician Should Know about Tuberculosis Henry F. Chambers, M.D Professor of Medicine, UCSF Topics for Discussion Microbiology Epidemiology Common disease presentations Diagnosis of active

More information

Understanding and Managing Latent TB Infection Arnold, Missouri October 5, 2010

Understanding and Managing Latent TB Infection Arnold, Missouri October 5, 2010 Understanding and Managing Latent TB Infection Arnold, Missouri October 5, 2010 What is Latent TB Infection (LTBI)? Traci Hadley, RN October 5, 2010 LTBI or TB Disease? Presented by : Traci Hadley, RN

More information

What the Primary Physician Should Know about Tuberculosis. Topics for Discussion. Global Impact of TB

What the Primary Physician Should Know about Tuberculosis. Topics for Discussion. Global Impact of TB What the Primary Physician Should Know about Tuberculosis Henry F. Chambers, M.D Professor of Medicine, UCSF Topics for Discussion Epidemiology Common disease presentations Diagnosis of active TB Screening

More information

Interferon Gamma Release Assay Testing for Latent Tuberculosis Infection: Physician Guidelines

Interferon Gamma Release Assay Testing for Latent Tuberculosis Infection: Physician Guidelines Interferon Gamma Release Assay Testing for Latent Tuberculosis Infection: Physician Guidelines Historically, Latent Tuberculosis Infection (LTBI) diagnosis was based on risk assessment, chest x-ray (CXR)

More information

Didactic Series. Latent TB Infection in HIV Infection

Didactic Series. Latent TB Infection in HIV Infection Didactic Series Latent TB Infection in HIV Infection Jacqueline Peterson Tulsky, MD UCSF Positive Health Program at SFGH Medical Director SF, North Coast and East Bay AETC January 8, 2015 ACCREDITATION

More information

These recommendations will remain in effect until the national shortage of PPD solution has abated.

These recommendations will remain in effect until the national shortage of PPD solution has abated. Maryland Recommendations Regarding the National Shortage of Purified Protein Derivative (PPD) Solution; Attachment to Health Officer Memorandum National Shortages of Tubersol and Aplisol for TB Skin Testing;

More information

LTBI: Who to Test & When to Treat

LTBI: Who to Test & When to Treat LTBI: Who to Test & When to Treat TB Intensive May 10 th, 2016 David Horne, MD, MPH Harborview Medical Center University of Washington DISCLOSURES I have no disclosures or conflicts of interest to report

More information

TB Intensive San Antonio, Texas November 11 14, 2014

TB Intensive San Antonio, Texas November 11 14, 2014 TB Intensive San Antonio, Texas November 11 14, 2014 Tuberculosis Pathogenesis and Treatment of Latent TB Infection Lynn Horvath, MD November 11, 2014 Lynn Horvath, MD has the following disclosures to

More information

Didactic Series. Latent TB Infection in HIV Infection

Didactic Series. Latent TB Infection in HIV Infection Didactic Series Latent TB Infection in HIV Infection Jacqueline Peterson Tulsky, MD UCSF Positive Health Program at SFGH Medical Director, SF and North Coast AETC March 13, 2014 ACCREDITATION STATEMENT:

More information

Tuberculosis: Where Are We Now?

Tuberculosis: Where Are We Now? Tuberculosis: Where Are We Now? Amee Patrawalla MD MPH Rutgers - NJ Medical School Global TB Institute Rutgers, The State University of New Jersey Learning Objectives Understand the current epidemiologic

More information

TB Intensive Houston, Texas October 15-17, 2013

TB Intensive Houston, Texas October 15-17, 2013 TB Intensive Houston, Texas October 15-17, 2013 Tuberculosis Pathogenesis and Treatment f Latent TB Infection Lynn Horvath, MD October 15, 2013 Lynn Horvath, MD has the following disclosures to make: No

More information

Jeffrey R. Starke, M.D. has the following disclosures to make:

Jeffrey R. Starke, M.D. has the following disclosures to make: AAP 2018 Red Book Tuberculosis: IGRAs and Treatment of TB Infection Jeffrey R. Starke, M.D. May 31, 2018 AAP 2018 Red Book Childhood Tuberculosis: IGRAs and Treatment of TB Infection May 31, 2018 WEBINAR

More information

Interpretation of TST & IGRA results. Objectives

Interpretation of TST & IGRA results. Objectives Interpretation of TST & IGRA results Randall Reves, MD, MSc Volunteer Clinician Denver Metro TB Program and Division of Infectious Diseases, Department of Medicine University of Colorado Denver Objectives

More information

Testing & Treatment for TB Infection: Blood Tests, Skin Tests, Who to Screen & Who to Treat?

Testing & Treatment for TB Infection: Blood Tests, Skin Tests, Who to Screen & Who to Treat? NECHA 11/4/2016 Testing & Treatment for TB Infection: Blood Tests, Skin Tests, Who to Screen & Who to Treat? E. Jane Carter, M.D. Immediate Past President International Union Against TB and Lung Disease

More information

Self-Study Modules on Tuberculosis

Self-Study Modules on Tuberculosis Self-Study Modules on Tuberculosis Targe te d Te s ting and the Diagnosis of Latent Tuberculosis Infection and Tuberculosis Disease U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control

More information

Tuberculosis Tools: A Clinical Update

Tuberculosis Tools: A Clinical Update Tuberculosis Tools: A Clinical Update CAPA Conference 2014 JoAnn Deasy, PA-C. MPH, DFAAPA jadeasy@sbcglobal.net Adjunct Faculty Touro PA Program Learning Objectives Outline the pathogenesis of active pulmonary

More information

Tuberculosis Update. Topics to be Addressed

Tuberculosis Update. Topics to be Addressed Tuberculosis Update Robert M. Jasmer, M.D. University of California, San Francisco TB Control Section, San Francisco Department of Public Health Topics to be Addressed TB in the USA Screening recommendations

More information

Detecting latent tuberculosis using interferon gamma release assays (IGRA)

Detecting latent tuberculosis using interferon gamma release assays (IGRA) Detecting latent tuberculosis using interferon gamma release assays (IGRA) American Society for Microbiology June 2017 Edward Desmond, Ph.D., D (ABMM) San Lorenzo, CA Edward Desmond has no financial connections

More information

Diagnosis and Management of Latent TB Infection Douglas Hornick, MD September 27, 2011

Diagnosis and Management of Latent TB Infection Douglas Hornick, MD September 27, 2011 TB Nurse Case Management Davenport, Iowa September 27 28, 2011 Diagnosis and Management of Latent TB Infection Douglas Hornick, MD September 27, 2011 Douglas Hornick, MD has the following disclosures to

More information

Targeted Testing and the Diagnosis of. Latent Tuberculosis. Infection and Tuberculosis Disease

Targeted Testing and the Diagnosis of. Latent Tuberculosis. Infection and Tuberculosis Disease Self-Study Study Modules on Tuberculosis Targeted Testing and the Diagnosis of Latent Tuberculosis Infection and Tuberculosis Disease 1 Module 3: Objectives At completion of this module, learners will

More information

TB Update: March 2012

TB Update: March 2012 TB Update: March 2012 David Schlossberg, MD, FACP Medical Director, TB Control Program Philadelphia Department of Public Health 1 TB Update: March 2012 IGRAs vs TST LTBI A New Regimen NAATs What is Their

More information

The Most Widely Misunderstood Test of All

The Most Widely Misunderstood Test of All The Most Widely Misunderstood Test of All Lee B. Reichman, MD, MPH NJMS Global Tuberculosis Institute History of Treatment of Latent Tuberculosis Infection For more than 4 decades, treatment of persons

More information

Fundamentals of Tuberculosis (TB)

Fundamentals of Tuberculosis (TB) TB in the United States Fundamentals of Tuberculosis (TB) From 1953 to 1984, reported cases decreased by approximately 5.6% each year From 1985 to 1992, reported cases increased by 20% 25,313 cases reported

More information

Treatment of TB Infection Lisa Y. Armitige, MD, PhD April 7, 2015

Treatment of TB Infection Lisa Y. Armitige, MD, PhD April 7, 2015 Treatment of TB Infection Lisa Y. Armitige, MD, PhD April 7, 2015 Tuberculosis Infection Diagnosis and Treatment April 7, 2015 El Paso, TX EXCELLENCE EXPERTISE INNOVATION Lisa Y. Armitige, MD, PhD has

More information

Community pharmacy-based tuberculosis skin testing

Community pharmacy-based tuberculosis skin testing Community pharmacy-based tuberculosis skin testing Shanna K. O Connor, PharmD ISU KDHS Spring CE Seminar 2018 In support of improving patient care, Idaho State University Kasiska Division of Health Sciences

More information

Latent Tuberculosis Best Practices

Latent Tuberculosis Best Practices Latent Tuberculosis Best Practices Last Updated September 7, 2016 LTBI Demographics in the US o 13million people in the US with LTBI (estimate) o In 2014, approximately 66% of TB cases in the United States

More information

2016 OPAM Mid-Year Educational Conference, Sponsored by AOCOPM Sunday, March 13, 2016

2016 OPAM Mid-Year Educational Conference, Sponsored by AOCOPM Sunday, March 13, 2016 Learning Objectives Tuberculosis Case Discussions: Evaluation for Tuberculosis Infection Melissa C. Overman, DO, MPH, CHES, FAOCOPM Describe appropriate technique for TST placement, reading and interpretation

More information

TB is Global. Latent TB Infection (LTBI) Sharing the Care: Working Together. September 24, 2014

TB is Global. Latent TB Infection (LTBI) Sharing the Care: Working Together. September 24, 2014 Sharing the Care: Working Together to Meet the Challenge of TB Presented by: Barbara Cole, RN, PHN, MSN Director, Disease Control County of Riverside Department of Public Health Curry International TB

More information

Tuberculosis and Diabetes Mellitus. Lana Kay Tyer, RN MSN WA State Department of Health TB Nurse Consultant

Tuberculosis and Diabetes Mellitus. Lana Kay Tyer, RN MSN WA State Department of Health TB Nurse Consultant Tuberculosis and Diabetes Mellitus Lana Kay Tyer, RN MSN WA State Department of Health TB Nurse Consultant Learning Objectives Understand the impact of uncontrolled diabetes mellitus (DM) on TB infection

More information

Let s Talk TB A Series on Tuberculosis, A Disease That Affects Over 2 Million Indians Every Year

Let s Talk TB A Series on Tuberculosis, A Disease That Affects Over 2 Million Indians Every Year A Series on Tuberculosis, A Disease That Affects Over 2 Million Indians Every Year Madhukar Pai, MD, PhD Author and Series Editor Camilla Rodrigues, MD co-author Abstract Most individuals who get exposed

More information

TB Nurse Case Management San Antonio, Texas March 7 9, Clinical Diagnosis and

TB Nurse Case Management San Antonio, Texas March 7 9, Clinical Diagnosis and TB Nurse Case Management San Antonio, Texas March 7 9, 2012 Clinical Diagnosis and Management of LTBI Lynn Horvath, MD March 7, 2012 Lynn Horvath, MD has the following disclosures to make: No conflict

More information

Pediatric Tuberculosis Lisa Y. Armitige, MD, PhD September 14, 2017

Pediatric Tuberculosis Lisa Y. Armitige, MD, PhD September 14, 2017 Pediatric Tuberculosis Lisa Y. Armitige, MD, PhD September 14, 2017 TB Nurse Case Management September 12 14, 2017 EXCELLENCE EXPERTISE INNOVATION Lisa Y. Armitige, MD, PhD has the following disclosures

More information

The Challenges and Pitfalls in Diagnosing or Misdiagnosing Tuberculosis: Are the Days of TB Skin Tests Over?

The Challenges and Pitfalls in Diagnosing or Misdiagnosing Tuberculosis: Are the Days of TB Skin Tests Over? The Challenges and Pitfalls in Diagnosing or Misdiagnosing Tuberculosis: Are the Days of TB Skin Tests Over? ROY F. CHEMALY, MD, MPH, FIDSA, FACP PROFESSOR OF MEDICINE DIRECTOR, INFECTION CONTROL SECTION

More information

Diagnosis of Tuberculosis Infection and Disease

Diagnosis of Tuberculosis Infection and Disease Diagnosis of Tuberculosis Infection and Disease David E. Griffith, M.D. Assistant Medical Director Heartland National TB Center The Medical Evaluation for Diagnosing Tuberculosis Traditional Approach Patient

More information

Tuberculosis Populations at Risk

Tuberculosis Populations at Risk Tuberculosis Populations at Risk One-third of the world is infected with TB, an average of one new infection per second Two million people died from tuberculosis in 2010, 1 every 20 seconds TB is the leading

More information

Disclosures. Updates in TB for the PCP: Opportunities for Prevention. Objectives PART 1: WHY TEST? 4/14/2016. None

Disclosures. Updates in TB for the PCP: Opportunities for Prevention. Objectives PART 1: WHY TEST? 4/14/2016. None Disclosures Updates in TB for the PCP: Opportunities for Prevention None Pennan Barry, MD, MPH Chief, Surveillance and Epidemiology, California TB Control Branch Assistant Clinical Professor, Division

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE TB Partial Update Appendix 1 - Scope NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Tuberculosis: interferon gamma tests for the diagnosis of latent tuberculosis (partial

More information

Diagnosis and Medical Management of LTBI

Diagnosis and Medical Management of LTBI TB Nurse Case Management San Antonio, Texas December 8-10, 2009 Diagnosis and Medical Management of LTBI Barbara Seaworth, MD December 8, 2009 CLINICAL DIAGNOSIS AND MANAGEMENT OF LATENT TB INFECTION Barbara

More information

Latent TB, TB and the Role of the Health Department

Latent TB, TB and the Role of the Health Department Latent TB, TB and the Role of the Health Department Elaine Darnall, RN, BSN, CIC TB Nurse Consultant Illinois Dept of Public Health March 21, 2018 Elaine Darnall has disclosed that there is no actual or

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Tuberculosis: interferon gamma tests for the diagnosis of latent tuberculosis (partial update) 1.1 Short title Tuberculosis

More information

Tuberculosis Screening and Targeted Testing of College and University Students: Developing a Best Practice Approach:

Tuberculosis Screening and Targeted Testing of College and University Students: Developing a Best Practice Approach: Tuberculosis Screening and Targeted Testing of College and University Students: Developing a Best Practice Approach: Lori A. Soos MA, BSN, RN, Niagara University Deborah Penoyer, MS, RN, SUNY Geneseo Learning

More information

Tuberculin Skin Test (TST) and Interferon-gamma Release Assays (IGRA)

Tuberculin Skin Test (TST) and Interferon-gamma Release Assays (IGRA) Tuberculin Skin Test (TST) and Interferon-gamma Release Assays (IGRA) April 2019 Bob Belknap M.D. Director, Denver Metro TB Program Disclosures No relevant financial relationships Objectives Be able to

More information

Thorax Online First, published on December 8, 2009 as /thx

Thorax Online First, published on December 8, 2009 as /thx Thorax Online First, published on December 8, 2009 as 10.1136/thx.2009.119677 Title Page Cost effectiveness of the NICE guidelines for screening for latent tuberculosis infection: the Quantiferon-TB gold

More information

ATS/CDC Guidelines for Treating Latent TB Infection

ATS/CDC Guidelines for Treating Latent TB Infection TB Intensive Tyler, Texas June 2-4, 2010 ATS/CDC Guidelines for Treating Latent TB Infection Timothy R. Aksamit, MD June 2, 2010 ATS/CDC Guidelines for Treating LTBI Tuberculosis Intensive University of

More information

Testing for TB. Bart Van Berckelaer Territory Manager Benelux. Subtitle

Testing for TB. Bart Van Berckelaer Territory Manager Benelux. Subtitle Testing for TB Bart Van Berckelaer Territory Manager Benelux Subtitle Agenda TB infection pathway TB immunisation Testing options Pre lab considerations of the whole blood ELISA test The T-SPOT.TB test

More information

Latent Tuberculosis Infection (LTBI) Questions and Answers for Health Care Providers

Latent Tuberculosis Infection (LTBI) Questions and Answers for Health Care Providers Latent Tuberculosis Infection (LTBI) Questions and Answers for Health Care Providers Who Should Be Screened for Latent Tuberculosis Infection (LTBI)?... 2 What tests are used to screen for LTBI?... 2 How

More information

Tuberculin Skin Testing

Tuberculin Skin Testing Understanding and Managing Latent TB Infection Arnold, Missouri October 5, 2010 Testing to TB Infection Using the TST Presented by Debra Howenstine, MD for Debbie Onofre, RN October 5, 2010 Tuberculin

More information

ESCMID Online Lecture Library. by author

ESCMID Online Lecture Library. by author Tuberculosis prevention in immunodepressed patients M. Carmen Fariñas Álvarez Infectious Diseases.H.U.Marqués de Valdecilla University of Cantabria, Spain DISCLOSURES I have no potential conflicts with

More information

11/1/2017. Disclosures. Update In Tuberculosis, Indiana Outline/Objectives. Pathogenesis of M.tb Global/U.S. TB Burden, 2016

11/1/2017. Disclosures. Update In Tuberculosis, Indiana Outline/Objectives. Pathogenesis of M.tb Global/U.S. TB Burden, 2016 Disclosures Update In Tuberculosis, Indiana 2017 Bradley Allen, MD, PhD, FACP, FIDSA Indiana University School of Medicine Division of Infectious Diseases Roudebush VAMC Indianapolis Medical Consultant,

More information

TUBERCULOSIS. Pathogenesis and Transmission

TUBERCULOSIS. Pathogenesis and Transmission TUBERCULOSIS Pathogenesis and Transmission TUBERCULOSIS Pathogenesis and Transmission Infection to Disease Diagnostic & Isolation Updates Treatment Updates Pathogenesis Droplet nuclei of 5µm or less are

More information

PREVENTION OF TUBERCULOSIS. Dr Amitesh Aggarwal

PREVENTION OF TUBERCULOSIS. Dr Amitesh Aggarwal PREVENTION OF TUBERCULOSIS Dr Amitesh Aggarwal 25 to 50 % of persons exposed to intimate contact with active PTB - latent infection with TB. Exposure to index case for 12 hours - high risk of infection.

More information

10/3/2017. Updates in Tuberculosis. Global Tuberculosis, WHO 2015 report. Objectives. Disclosures. I have nothing to disclose

10/3/2017. Updates in Tuberculosis. Global Tuberculosis, WHO 2015 report. Objectives. Disclosures. I have nothing to disclose Disclosures Updates in Tuberculosis I have nothing to disclose Chris Keh, MD Assistant Clinical Professor, Division of Infectious Diseases, UCSF TB Controller, TB Prevention and Control Program, Population

More information

LATENT TUBERCULOSIS SCREENING AND TREATMENT:

LATENT TUBERCULOSIS SCREENING AND TREATMENT: LATENT TUBERCULOSIS SCREENING AND TREATMENT: TB or not TB Christopher Kwong, MD and William Rifkin, MD Week 14 Educational Objectives: 1. Understand who should be screened for latent TB infection and why

More information

Therapy for Latent Tuberculosis Infection

Therapy for Latent Tuberculosis Infection Screening and Treatment of LTBI in TB Control in the US Margarita Elsa Villarino MD MPH Division of TB Elimination, CDC April 14, 2004 TB Prevention and Control in the United States The fundamental strategies

More information

New Approaches to the Diagnosis and Management of Tuberculosis Infection in Children and Adolescents

New Approaches to the Diagnosis and Management of Tuberculosis Infection in Children and Adolescents New Approaches to the Diagnosis and Management of Tuberculosis Infection in Children and Adolescents Jeffrey R. Starke, M.D. Professor of Pediatrics Baylor College of Medicine [With great thanks to Andrea

More information

Please distribute a copy of this information to each provider in your organization.

Please distribute a copy of this information to each provider in your organization. HEALTH ADVISORY TO: Physicians and other Healthcare Providers Please distribute a copy of this information to each provider in your organization. Questions regarding this information may be directed to

More information

Table 9. Policy for Tuberculosis Surveillance and Screening

Table 9. Policy for Tuberculosis Surveillance and Screening Policy for Tuberculosis Surveillance and Screening Purpose: to identify active cases of tuberculosis or latent TB among residents and staff of the nursing home in order to prevent transmission in this

More information

TB Intensive. San San Antonio, Texas. December 1-3, 2010

TB Intensive. San San Antonio, Texas. December 1-3, 2010 TB Intensive San Antonio, Texas December 1-3, 2010 ATS/CDC Guidelines for Treating Latent TB Infection Timothy Aksamit, MD; Mayo Clinic December 1, 2010 ATS/CDC Guidelines for Treating LTBI Tuberculosis

More information

Tuberculin Skin Test (TST) and Interferon-gamma Release Assays (IGRA)

Tuberculin Skin Test (TST) and Interferon-gamma Release Assays (IGRA) Tuberculin Skin Test (TST) and Interferon-gamma Release Assays (IGRA) April 2018 Bob Belknap M.D. Director, Denver Metro TB Program No Disclosures Objectives be able to describe: 1. Who should get tested

More information

FLORIDA DEPARTMENT OF JUVENILE JUSTICE DETENTION SERVICES FACILITY MEDICAL POLICIES

FLORIDA DEPARTMENT OF JUVENILE JUSTICE DETENTION SERVICES FACILITY MEDICAL POLICIES FLORIDA DEPARTMENT OF JUVENILE JUSTICE DETENTION SERVICES FACILITY MEDICAL POLICIES Superintendent Signature Designated Health Authority Signature Effective Date: November 1, 2016 Subject: TUBERCULOSIS

More information

IGRAs for Diagnosis of Tuberculosis: 2010 Update

IGRAs for Diagnosis of Tuberculosis: 2010 Update IGRAs for Diagnosis of Tuberculosis: 2010 Update Nira Pollock, M.D., Ph.D. Division of Infectious Diseases Beth Israel Deaconess Medical Center Boston, MA May 1, 2010 Problems with the PPD False positives

More information

The Origin of Swine Flu

The Origin of Swine Flu How the Heck Do You Diagnose Tuberculosis in Children, Anyway? Jeffrey R. Starke, M.D. Professor and Vice Chairman of Pediatrics Baylor College of Medicine Houston, Texas USA The Origin of Swine Flu MAIN

More information

New NICE guideline updates recommendations for diagnosing latent tuberculosis

New NICE guideline updates recommendations for diagnosing latent tuberculosis Tel: 0845 003 7782 www.nice.org.uk Ref: 2011/053 PRESS RELEASE New NICE guideline updates recommendations for diagnosing latent tuberculosis The National Institute for Health and Clinical Excellence (NICE)

More information

Contact Investigation

Contact Investigation Tuberculosis Ann Raftery, RN, PHN, MSc GHS Learning Objectives Upon completion of this session, participants will be able to: Describe the criteria used and method for determining the infectious period

More information

Preventing Tuberculosis (TB) Transmission in Ambulatory Surgery Centers. Heidi Behm, RN, MPH TB Controller HIV/STD/TB Program

Preventing Tuberculosis (TB) Transmission in Ambulatory Surgery Centers. Heidi Behm, RN, MPH TB Controller HIV/STD/TB Program Preventing Tuberculosis (TB) Transmission in Ambulatory Surgery Centers Heidi Behm, RN, MPH TB Controller HIV/STD/TB Program Topics of Discussion TB Overview Epidemiology of TB in Oregon Annual Facility

More information

Advanced Concepts in Pediatric Tuberculosis

Advanced Concepts in Pediatric Tuberculosis Advanced Concepts in Pediatric Tuberculosis: Nizar F. Maraqa, MD, FPIDS Division of Pediatric Infectious Diseases & Immunology University of Florida College of Medicine - Jacksonville Advanced Concepts

More information

Evaluation and Management of the Patient with Latent Tuberculosis Infection (LTBI)

Evaluation and Management of the Patient with Latent Tuberculosis Infection (LTBI) Evaluation and Management of the Patient with Latent Tuberculosis Infection (LTBI) CURTIS FOWLER MPT,PA C ASSISTANT CLINICAL PROFESSOR UNIVERSITY OF THE PACIFIC Learning objectives Recognize the appropriate

More information

결핵노출접촉자감염관리 서울아산병원감염내과 김성한

결핵노출접촉자감염관리 서울아산병원감염내과 김성한 결핵노출접촉자감염관리 서울아산병원감염내과 김성한 TB incidence (2012) TB incidence South Korea 108 China 73 Taiwan 68 Portucal 26 Japan 19 Spain 14 US 3.6 * unit- per 100,000 population Adapted from WHO Adapted from WHO Emerg

More information